Medicina

144 KiB

Open AccessArticle

Sudėtinės kontraceptinės tabletės ir hiperkoaguliacija

by Dalia Adukauskienė and Viktorija Miliauskienė

Medicina 2010, 46(4), 293; https://doi.org/10.3390/medicina46040041 - 11 Apr 2010

Viewed by 751

Sudėtinės kontraceptinės tabletės yra gerai žinomas kontracepcijos metodas daugiau kaip 50 metų. Deja, šis metodas nėra visiškai saugus. Sudėtinių kontraceptinių tablečių sudėtyje yra estrogenų bei progestagenų, kurie gali skatinti kraujo krešėjimą ir giliųjų venų trombozę, taip pat su geriamųjų kontraceptikų vartojimu siejami nepageidaujami [...] Read more.

Sudėtinės kontraceptinės tabletės yra gerai žinomas kontracepcijos metodas daugiau kaip 50 metų. Deja, šis metodas nėra visiškai saugus. Sudėtinių kontraceptinių tablečių sudėtyje yra estrogenų bei progestagenų, kurie gali skatinti kraujo krešėjimą ir giliųjų venų trombozę, taip pat su geriamųjų kontraceptikų vartojimu siejami nepageidaujami reiškiniai: žymiai padidėjusi insulto ir miokardo infarkto rizika. Labiausiai tikėtina, jog hiperkoaguliacijos ir veninės trombozės rizika priklauso nuo estrogenų dozės, bet naujausių tyrimų duomenys parodė, jog progestagenų rūšis taip pat yra reikšminga. Full article

187 KiB

Open AccessArticle

Cost-utility analysis of methadone maintenance treatment in Lithuania

by Giedrius Vanagas, Žilvinas Padaiga and Eugenijus Bagdonas

Medicina 2010, 46(4), 286; https://doi.org/10.3390/medicina46040040 - 11 Apr 2010

Cited by 15 | Viewed by 948

Abstract

Background. Economic evaluations in health care involve the identification, measurement, valuation, and then comparison of the costs (inputs) and outcomes of treatments or preventive activities. The aim was to analyze the cost-utility of six-month methadone maintenance treatment program in a Lithuanian primary [...] Read more.

Background. Economic evaluations in health care involve the identification, measurement, valuation, and then comparison of the costs (inputs) and outcomes of treatments or preventive activities. The aim was to analyze the cost-utility of six-month methadone maintenance treatment program in a Lithuanian primary health care setting.
Methods. A prospective study design was used. All the information was obtained through the validated questionnaires at the baseline and 3- and 6-month follow-ups. WHOQOL-BREF was used to assess the quality of life; the costs were assessed using the DATCAP methodology from the perspective of a patient and outpatient clinic during follow-up period.
Results. A total of 102 opioid-dependent patients were recruited in the study; 512 follow-up patient-months were obtained. The methadone maintenance treatment has significantly improved physical, psychological, and environmental components of quality of life during follow-up. Total program costs were 61 288.87 EUR. Cost paid by a patient comprised about 31% of total program costs. Cost per quality-adjusted life-month (QALM) for physical domain was 2227.55 EUR; for psychological domain, 1879.50 EUR; for social domain, 5467.64 EUR; and for environmental domain, 4626.47 EUR. Costs per QALM and quality-adjusted life-year (QALY) for total quality of life in the maintenance program were 2864.00 EUR and 34 368.00 EUR, respectively.
Conclusions. Our results showed that 6-month methadone maintenance program was effective in the terms of quality-of-life improvement. Methadone maintenance treatment program was less effective in terms of cost per QALY. Full article

446 KiB

Open AccessArticle

Meningovascular neurosyphilis: a report of stroke in a young adult

by Antanas Vaitkus, Eglė Krasauskaitė and Inga Urbonavičiūtė

Medicina 2010, 46(4), 282; https://doi.org/10.3390/medicina46040039 - 11 Apr 2010

Cited by 10 | Viewed by 988

Abstract

A young adult patient with meningovascular neurosyphilis in the form of acute ischemic stroke with right hemiparesis and speech disturbance is reported. CT scan showed features of ischemic infarct and extensive laboratory studies were made before the diagnosis ultimately was revealed. Such cases [...] Read more.

A young adult patient with meningovascular neurosyphilis in the form of acute ischemic stroke with right hemiparesis and speech disturbance is reported. CT scan showed features of ischemic infarct and extensive laboratory studies were made before the diagnosis ultimately was revealed. Such cases could result in confusion for the clinician, and high index of clinical suspicion of this condition is required since syphilis is not routinely tested, as routine screening is seen to be of low diagnostic yield. As clinical practice indicates, it remains a difficult problem approaching diagnosis of neurosyphilis, and this is achieved through exclusion of neurosyphilis as a clinical possibility. Full article

299 KiB

Open AccessArticle

Secondary thrombosis of the left internal carotid artery caused by a motor vehicle accident: a radiological case

by Goda Randakevičienė, Rymantė Gleiznienė, Daiva Rastenytė and Saulius Lukoševičius

Medicina 2010, 46(4), 275; https://doi.org/10.3390/medicina46040038 - 11 Apr 2010

Viewed by 748

Abstract

rare case of occlusion of the internal carotid artery following a motor vehicle accident in a 34-year-old female victim who initially presented with clear consciousness and had normal computed tomogram of the brain is reported. Seven hours after the accident, the patient was [...] Read more.

rare case of occlusion of the internal carotid artery following a motor vehicle accident in a 34-year-old female victim who initially presented with clear consciousness and had normal computed tomogram of the brain is reported. Seven hours after the accident, the patient was unexpectedly diagnosed with the left hemisphere infarction, and two days later, she suffered from right hemiplegia and coma. The follow-up brain computed tomography scan showed an acute infarction of the left hemisphere of the cerebrum and severe cerebral edema. Anticoagulation therapy was administered, and emergency craniotomy for brain decompression was carried out. After 3.5 months, she was discharged and underwent regular follow-up in the outpatient department. Four years after the motor vehicle accident, the patient had intact awareness, was functionally independent, but remained with motor aphasia, right hand paralysis, and right leg paresis. Full article

246 KiB

Open AccessArticle

Folikulinio skydliaukės vėžio ilgalaikio kompleksinio gydymo rezultatai

by Zenonas Baranauskas, Konstantinas Povilas Valuckas and Sigitas Tiškevičius

Medicina 2010, 46(4), 268; https://doi.org/10.3390/medicina46040037 - 11 Apr 2010

Cited by 2 | Viewed by 711

Abstract

Tyrimo tikslas. Ištirti folikuliniu skydliaukės vėžiu sergančiųjų kompleksinio gydymo metodo (tiroidektomija+radiojodoterapija+hormonoterapija) įtaką išgyvenamumui.
Tyrimo medžiaga ir metodai. Atliktas retrospektyvusis tyrimas. Ištirti 448 pacientai (394 moterys, 54 vyrai, amžiaus vidurkis – 48 m. (95 proc. PI 46–50), sergantys folikuliniu skydliaukės vėžiu ir [...] Read more.

Tyrimo tikslas. Ištirti folikuliniu skydliaukės vėžiu sergančiųjų kompleksinio gydymo metodo (tiroidektomija+radiojodoterapija+hormonoterapija) įtaką išgyvenamumui.
Tyrimo medžiaga ir metodai. Atliktas retrospektyvusis tyrimas. Ištirti 448 pacientai (394 moterys, 54 vyrai, amžiaus vidurkis – 48 m. (95 proc. PI 46–50), sergantys folikuliniu skydliaukės vėžiu ir gydyti nuo 1982 iki 2006 m. Vilniaus universiteto Onkologijos institute. Visiems tiriamiesiems atliktos tiroidektomijos. Po operacijos tiriamieji buvo gydyti radiojodoterapija – ¹³¹J. Tiriamiesiems skirta pakaitinė-supresinė hormonoterapija tiroksinu. Baigus gydymą, tiriamieji pirmuosius metus buvo tirti kas 6 mėn., po to – kartą per metus. Duomenys apie gydytus ligonius įtraukti į duomenų bazę, analizuoti naudojant statistinės analizės programas (STATA, SPSS) ir Kaplano-Mejerio bei Cox proporcinės rizikos modelius.
Rezultatai. Visiems 448 pacientams po tiroidektomijos ir gydymo radiojodu scintigrafiškai ir skenografiškai skydliaukės projekcijoje buvo aptikta skydliaukės audinio ir naviko liekanų. Skydliaukės audinio ir naviko liekanoms sunaikinti buvo skirtos vidutinės suminės 131J dozės – 5,6±0,2 GBq. Sergantiesiems skydliaukės vėžiu ir esant metastazių plaučiuose, kauluose, kaklo ir tarpuplaučio limfmazgiuose, skirtos vidutinės suminės ¹³¹J dozės – 19,5±3,1 GBq. 91,2 proc. pacientų gavo pakankamą tiroidinių hormonų kiekį. Po kompleksinio gydymo stebimų pacientų tiroglobulino kiekis kraujyje neviršijo 1,1±0,2 ng/ml. Taikant šią skydliaukės folikulinio vėžio gydymo metodiką, nustatytas 10, 20, 30 metų išgyvenamumas atitinkamai – 91,2, 81,9, 77,1 proc.
Išvados. Lietuvoje sergantiesiems folikuliniu skydliaukės vėžiu taikomas kompleksinis gydymas (tiroidektomija+radiojodoterapija+hormonoterapija) yra efektyvus gydymo metodas. Gydant šiuo metodu, pasiektas aukštas išgyvenamumo lygis: 10 metų išgyveno 91,2 proc., 20 metų – 81,9 proc., 30 metų – 77,1 proc. pacientų. Full article

215 KiB

Open AccessArticle

The influence of dexamethasone and ketolgan on postoperative nausea and vomiting and estimation of risk factors in women undergoing gynecologic laparoscopic surgeries

by Kęstutis Rimaitis, Asta Svitojūtė and Andrius Macas

Medicina 2010, 46(4), 261; https://doi.org/10.3390/medicina46040036 - 11 Apr 2010

Cited by 3 | Viewed by 836

Abstract

The aim of this study was to determine the effect of dexamethasone and ketolgan on postoperative nausea and vomiting and to evaluate risk factors for postoperative nausea and vomiting.
Material and methods. A prospective, double-blind, randomized clinical study was carried out. One [...] Read more.

The aim of this study was to determine the effect of dexamethasone and ketolgan on postoperative nausea and vomiting and to evaluate risk factors for postoperative nausea and vomiting.
Material and methods. A prospective, double-blind, randomized clinical study was carried out. One hundred fi fty-three ASA I–II women undergoing laparoscopic gynecologic operations were randomized into three groups: dexamethasone group (n=51), ketolgan group (n=51), and control group (n=51). Patients in the dexamethasone group were given 4 mg of dexamethasone intravenously before the induction of general anesthesia, the ketolgan group received 30-mg ketolgan intravenously, and control group did not receive any medication. The incidence and severity of postoperative nausea and vomiting were registered 24 hours after the surgery.
Results. The incidence of postoperative nausea and vomiting in the dexamethasone group was 13.8%; in the ketolgan group, 37.3%, and in the control group, 58.9% (P=0.026). Patients with a history of migraine suffered from postoperative nausea and vomiting in 70.3% of cases and migraine- free patients in 25.8% of cases (P=0.015). Opioids for postoperative analgesia increased the incidence of postoperative nausea and vomiting as compared with nonsteroidal anti-infl ammatory drugs (P=0.00002).
Conclusions. Preoperative medication with dexamethasone signifi cantly reduces the incidence of postoperative nausea and vomiting. Avoidance of opioids for postoperative analgesia reduces the incidence of postoperative nausea and vomiting. Migraine and motion sickness are independent risk factors for postoperative nausea and vomiting. Full article

136 KiB

Open AccessArticle

Clinical characteristics and long-term outcomes of 35 patients with Wegener’s granulomatosis followed up at two rheumatology centers in Lithuania

by Jolanta Dadonienė, Margarita Pileckytė, Asta Baranauskaitė and Gailutė Kirdaitė

Medicina 2010, 46(4), 256; https://doi.org/10.3390/medicina46040035 - 11 Apr 2010

Cited by 9 | Viewed by 738

Abstract

Objective. The aim of this study was to investigate the survival of Lithuanian patients with Wegener’s granulomatosis, who were followed up at two tertiary rheumatology centers, and to find the factors possibly influencing the outcomes of this disease.
Material and methods. [...] Read more.

Objective. The aim of this study was to investigate the survival of Lithuanian patients with Wegener’s granulomatosis, who were followed up at two tertiary rheumatology centers, and to find the factors possibly influencing the outcomes of this disease.
Material and methods. Thirty-five patients were followed up prospectively from the onset of disease (the first patient was enrolled in 1994) at Vilnius University Hospital and the Center of Rheumatology of Kaunas University of Medicine (17 and 18 patients, respectively). All patients in both the centers were followed up on a routine basis, and their records contained necessary information about laboratory and biopsy data; the censoring date (end of follow-up) was stated in June 2006.
Results. Among the patients, the most frequent organs involved were ear, nose, throat (ENT) (82.6%), lungs (74.3%), and kidney (renal involvement was defined by proteinuria/abnormal urine sediment) (45.7%). Renal insufficiency was present in 20.6% of all the patients. At the end of the study, 32.4% of patients had simultaneously all three organ systems involved, namely upper respiratory tract, pulmonary, and renal. ANCA positivity was found for 26 (74.3%) of all the patients. Overall mortality rate was 25.7% (9/35). The mean survival was 99.4 months (95% CI, 73.6; 125.3) limited to 149 months for the longest-surviving patient.

Conclusions. Female gender and all three specific organ involvements being present at the same time and higher vasculitis damage index were associated with poor outcome. Overall mortality rate was 25.7% (9/35) during the 12-year follow-up, and it is similar to the data from other European countries. Full article

313 KiB

Open AccessArticle

Interventional and surgical management of abdominal compartment syndrome in severe acute pancreatitis

by Žilvinas Dambrauskas, Audrius Paršeliūnas, Almantas Maleckas, Antanas Gulbinas, Giedrius Barauskas and Juozas Pundzius

Medicina 2010, 46(4), 249; https://doi.org/10.3390/medicina46040034 - 11 Apr 2010

Cited by 22 | Viewed by 928

Abstract

Background and objective. Management of the abdominal compartment syndrome during severe acute pancreatitis by the open abdomen method is associated with considerable morbidity and resource utilization. Thus, the aim of this study was to evaluate the safety and efficacy of the ultrasound-guided [...] Read more.

Background and objective. Management of the abdominal compartment syndrome during severe acute pancreatitis by the open abdomen method is associated with considerable morbidity and resource utilization. Thus, the aim of this study was to evaluate the safety and efficacy of the ultrasound-guided percutaneous interventions and/or minimally invasive surgery in the treatment of abdominal compartment syndrome.
Material and methods. Forty-four patients with severe acute pancreatitis were enrolled into a prospective study and treated according to the standard management protocol. Interventional and/ or surgical management of abdominal compartment syndrome was employed in 6 (13.6%) cases. In the context of this study, we assessed the feasibility and effectiveness of subcutaneous fasciotomy of the anterior m. rectus abdominis sheath, as well as the role of ultrasound-guided drainage of intra-abdominal and peripancreatic fluid collections in the management of abdominal compartment syndrome.
Results. Subcutaneous fasciotomy of the anterior m. rectus sheath and ultrasound-guided drainage of intra-abdominal and peripancreatic fluid collections seem to be safe (minor risk of bleeding or infection, closed abdomen, and easy care for the patient) and effective (resulted in a sustained decrease of intra-abdominal pressure to 13–16 mm Hg and regression of organ failures after intervention). Subcutaneous anterior m. rectus fasciotomy may appear to be beneficial in case of refractory abdominal compartment syndrome avoiding morbidity associated with the open abdomen technique.
Conclusions. Both the subcutaneous fasciotomy and ultrasound-guided drainage of intra-abdominal and/or peripancreatic fluid collections seem to be safe and effective alternatives in the management of abdominal compartment syndrome; however, prospective studies are needed to further evaluate their clinical role. Full article

531 KiB

Open AccessArticle

Tigecycline – how powerful is it in the fight against antibiotic-resistant bacteria?

by Vaida Šeputienė, Justas Povilonis, Julija Armalytė, Kęstutis Sužiedėlis, Alvydas Pavilonis and Edita Sužiedėlienė

Medicina 2010, 46(4), 240; https://doi.org/10.3390/medicina46040033 - 11 Apr 2010

Cited by 24 | Viewed by 1083

Abstract

Tigecycline is a semisynthetic analogue of earlier tetracyclines and represents the first member of a novel class of antimicrobials – glycylcyclines – recently approved for clinical use. It is active against a broad range of gram-negative and gram-positive bacterial species including clinically important [...] Read more.

Tigecycline is a semisynthetic analogue of earlier tetracyclines and represents the first member of a novel class of antimicrobials – glycylcyclines – recently approved for clinical use. It is active against a broad range of gram-negative and gram-positive bacterial species including clinically important multidrug-resistant nosocomial and community-acquired bacterial pathogens. The exact molecular basis of tigecycline action is not clear at present, although similarly to the tetracyclines, it has been shown to inhibit the translation elongation step by binding to the ribosome 30S subunit and preventing aminoacylated tRNAs to accommodate in the ribosomal A site. Importantly, tigecycline overcomes the action of ribosomal protection proteins and is not a substrate for tetracycline efflux pumps of most bacteria – well-known and prevalent cellular mechanisms of microbial tetracycline resistance. The present review summarizes current knowledge on the molecular mechanism of the tigecycline action, antibacterial activity against various bacteria, clinical application, development of resistance to glycylcyclines. Full article

188 KiB

Open AccessReview

Immune factors in human embryo culture and their significance

by Živilė Čerkienė, Audronė Eidukaitė and Audronė Usonienė

Medicina 2010, 46(4), 233; https://doi.org/10.3390/medicina46040032 - 11 Apr 2010

Cited by 5 | Viewed by 747

Abstract

There is increasing evidence that human development before implantation is regulated by embryonically and maternally derived growth factors. The “regulators” of embryonic origin such as soluble human leukocyte antigen G, platelet-activating factor, Th1/Th2 cytokines, insulinlike growth factor, epidermal growth factor, transforming growth factor [...] Read more.

There is increasing evidence that human development before implantation is regulated by embryonically and maternally derived growth factors. The “regulators” of embryonic origin such as soluble human leukocyte antigen G, platelet-activating factor, Th1/Th2 cytokines, insulinlike growth factor, epidermal growth factor, transforming growth factor α, colony-stimulating factor, platelet-derived growth factor may be used as indicators of embryo viability and implantation potential. The data prove the infl uence of growth factors on the development and growth of preimplantation embryos. Though there is a lot of research in the field of biomarkers during folliculogenesis and maternal-fetal interface, only few of them deal with regulators derived from embryonic cells to the cultivation medium. The aim of our study was to summarize the research dealing with immune markers produced by embryos in vitro and to estimate their impact on the cell growth, viability and implantation potential. Full article

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Medicina, Volume 46, Issue 4 (April 2010) – 10 articles

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